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Stakeholder Insight: Cognitive Impairment in Schizoaffective Disorder

Inevitable or Treatable?

Publication Date   October 2005
Publisher   Datamonitor
Product Type   Report
Pages   259
ISBN Number   not applicable
Product Code   DAT379
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Price £8,695.00

approximately: $16,246 | €11,028

Summary


Cognitive impairment is regarded as a core deficit of schizophrenia; the primary unmet need is the availability of an effective drug for the treatment of cognitive impairment in schizophrenia (CIS). However manufacturers will need to carefully consider how to develop and market such a drug, and increase awareness of the disorder in patients, carers and prescribers.

Highlights

According to Datamonitor's primary physician research, CIS is perceived to be prevalent in 60% of the schizophrenia population, although the rate is likely to be even higher. However, CIS is currently diagnosed in fewer than 40% of patients, with a treatment rate that is even lower.Manufacturers need to increase physician awareness of specifically testing for cognitive impairment during or soon after the initial diagnosis of schizophrenia, in order to maximize long-term CIS drug revenues.In the absence of an approved drug therapy for CIS, treatment primarily consists of atypical antipsychotic therapy. However, numerous drugs are in development for CIS utilizing a variety of drug mechanisms, although Datamonitor believes that it is unlikely that a drug will be approved for CIS in the next five years.

Scope

  • Analysis of a survey of 185 prescribing psychiatrists in the seven major markets as well as in-depth interviews with CIS Key Opinion Leaders
  • Detailed treatment trees showing the prevalence, diagnosis and treatment rates of CIS across the seven major markets
  • Analysis of specific treatment strategies to improve cognition once CIS has been diagnosed
  • Insight into diagnostic and therapeutic unmet needs, and recommendations to aid market penetration and maximize prescription rates

Reasons to Purchase

  • Understand the diagnosis and treatment pathways in CIS and assess differential treatment and unmet needs in CIS
  • Design patient and physician awareness campaigns based upon patient and advocacy response and commercial analysis
  • Enhance development and market penetration strategies of CIS drugs

Content


  • Chapter 1 Executive Summary
    • Scope of the analysis
    • Datamonitor insight into the CIS market
    • Key metrics
  • Chapter 2 Introduction And Scope
    • Coverage of the Stakeholder Insight Survey
    • Epidemiology and diagnosis of CIS
    • Treatment of CIS
    • Drug profiles
  • Chapter 3 Country Treatment Trees
    • US
    • Japan
    • France
    • Germany
    • Italy
    • Spain
    • UK
  • Chapter 4 Epidemiology & Patient Segmentation
    • Key findings
    • Cognitive impairment in schizophrenia: definition and classification
    • Diagnostic criteria of schizophrenia
    • A - Characteristic symptoms
    • B - Social/occupational dysfunction
    • C - Duration
    • D - Schizoaffective and mood disorder exclusion
    • E - Substance/general medical condition exclusion
    • F - Relationship to a pervasive developmental disorder
    • The seven domains of cognitive impairment in schizophrenia
    • CIS affects patient's quality of life - improvement of which may prove to be a useful endpoint in clinical trials
    • Epidemiology of CIS
    • Prevalence of CIS
    • Schizophrenia affects 1% of the population
    • CIS is stated as affecting 60% of patients with schizophrenia, although the true rate is likely to be higher
    • Half of CIS patients suffer from mild cognitive impairment
    • CIS is almost equally prevalent in males and females
    • More than one-third of CIS patients suffer from one or more comorbidities
    • Anxiety is the most prevalent comorbidity CIS
    • Substance and alcohol abuse is frequently observed in CIS
    • Depression affects one-third of CIS patients
    • Oppositional defiant disorder and conduct disorder is reported in one in five CIS patients
    • Speech/language disorder is reported in 13% of CIS patients
    • Autism and Asperger's disorder affects only 6% of CIS patients
    • Tic disorders and Tourette's syndrome are not frequently seen in CIS patients
    • Psychiatrists reported that prevalence of CIS increase with age, although this is not supported by clinical data
    • One-third of patients with CIS develop dementia in later life
    • Data suggests that onset of dementia occurs 10 years earlier in patients with CIS
    • Black box warnings restrict off-label antipsychotic use in elderly patients with dementia
  • Chapter 5 Diagnosis And Treatment Options
    • Key findings
    • Schizophrenia diagnostic guidelines
    • Summary of the diagnostic criteria for schizophrenia
    • Numerous cognitive tests are used by psychiatrists to assess cognitive impairment in schizophrenia
    • MiniMental State Examination
    • Positive and Negative Syndrome Assessment
    • Wechsler Memory Scale
    • Wisconsin Card Sorting Test
    • Neuropsychological Assessment Battery
    • Alzheimer's Disease Assessment Scale
    • There is insufficient physician awareness of CIS and the available assessment tools
    • MATRICS program provides consensus on clinical trial endpoints
    • Strategic trial design can support demonstration of drug efficacy in CIS
    • MATRICS recommendations for the clinical trial design for cognition enhancing drugs in schizophrenia
    • Treatment Units for Research on Neurocognition and Schizophrenia encourage scientific research into CIS
    • Less than 40% of patients with CIS are diagnosed
    • CIS is detected early during the course of schizophrenia in Japan, France and Germany
    • Positive symptoms remain the priority treatment domain of schizophrenia
    • Social cognition, attention and executive function are the most clinically important domains of CIS to treat
    • Guidelines for the treatment of schizophrenia provide little information on treating cognitive deficits
    • Pharmacological treatments for schizophrenia and CIS
    • Atypical antipsychotics
    • Olanzapine
    • Risperidone
    • Quetiapine
    • Aripiprazole
    • Ziprasidone
    • Amisulpride
    • Perospirone
    • Sertindole
    • Zotepine
    • Clozapine
    • Typical neuroleptics
    • Alzheimer's and dementia drugs
    • Donepezil
    • Rivastigmine
    • Galantamine
    • Memantine
    • Other drugs
    • Buflomedil
    • Citicoline
    • Benzodiazepines
    • Non-pharmacological therapy
    • Psychosocial therapy
    • Acute phase
    • Stabilization phase
    • Stable phase
    • CIS increases the already high economic burden of schizophrenia
  • Chapter 6 Prescribing Trends And Influencing Factors
    • Key findings
    • Prescribing trends
    • Atypical antipsychotics form more than 90% of schizophrenia maintenance treatment strategies
    • Zyprexa and Risperdal are the most frequently used antipsychotics in schizophrenia maintenance therapy
    • Only one-third of patients receive specific therapy for the treatment of cognitive impairment
    • Time restrictions, and limited finances and resources, curtail the use of psychosocial therapy in CIS
    • A variety of non-pharmacological therapeutic strategies are employed in the treatment of CIS
    • Four strategies predominate for improving cognitive functioning in schizophrenia
    • Switching from one atypical antipsychotic to another is the most frequently employed strategy to improve cognitive functioning
    • Switching atypical antipsychotics is employed in two-thirds of antipsychotic switching strategies
    • Risperdal and Zyprexa are the most frequent antipsychotics switched-to across the seven major markets
    • Abilify and Geodon are the most frequent antipsychotics switched-to in the US
    • Risperdal and Zyprexa are the most common antipsychotics switched-to in Europe and Japan
    • Addition of an adjunctive non-antipsychotic drug is the third most frequently implemented strategy to improve cognitive functioning
    • Addition of an anti-Alzheimer's drug is the most frequent adjunctive non-antipsychotic therapy employed to improve cognitive functioning
    • Aricept is the most frequent non-antipsychotic drug added-on to schizophrenia maintenance therapy to improve cognitive functioning
    • Aricept is the most frequent non-antipsychotic drug added-on to schizophrenia maintenance therapy in the US
    • Aricept is the most frequent non-antipsychotic drug stated to be added-on to schizophrenia maintenance therapy in Europe and Japan
    • Addition of an adjunctive antipsychotic drug is the fourth most frequently implemented strategy to improve cognitive functioning
    • Addition of atypical antipsychotics is the most frequent antipsychotics adjunctive therapy employed to improve cognitive functioning
    • Seroquel and Abilify are the most frequent antipsychotics added-on to schizophrenia maintenance therapy in the US
    • Zyprexa and Risperdal are the most frequent antipsychotics added-on to schizophrenia maintenance therapy in Europe and Japan
    • Patients remain on CIS therapy for approximately four months before switching to a second-line strategy
    • Switching to an alternative antipsychotic is the most frequently employed second-line strategy to improve cognitive functioning
    • Factors influencing physician decision making
    • Efficacy in improving the cognitive functioning in patients with CIS is the most likely attribute to influence physician drug choice
    • Abilify rated most highly for the treatment of cognitive symptoms of schizophrenia
    • Abilify rated most highly for the treatment of cognitive symptoms of schizophrenia in the US
    • Zyprexa rated most highly for the treatment of global symptoms of schizophrenia in Japan
    • Abilify rated most highly for the treatment of global symptoms of schizophrenia in France
    • Abilify rated most highly for the treatment of global symptoms of schizophrenia in Germany
    • Clozapine rated most highly for the treatment of global symptoms of schizophrenia in Italy and Spain
    • Clozapine rated most highly for the treatment of global symptoms of schizophrenia in the UK
  • Chapter 7 Improving Treatment Outcomes
    • Key findings
    • The primary unmet need is the availability of a drug for the treatment of CIS
    • Improved efficacy in multiple domains of cognitive impairment is desirable
    • Greater efficacy without compromising upon side-effect profiles
    • Increased public, patient and physician awareness and education
    • Improved cognitive assessment and diagnosis will drive physician prescribing
    • Numerous drugs with differing mechanisms of action are in development because the cause of CIS remains unknown
    • Psychiatrists are relatively unaware of the key drugs in development which show the greatest propensity to treat CIS
    • Top five drugs listed by interviewed psychiatrists in development with potential for the treatment of CIS
    • Other pipeline drugs with the potential for treatment of CIS
    • The future of CIS therapy
    • Adjunctive therapy offers the greatest potential
    • Approved drugs will be prescribed for CIS, newly diagnosed schizophrenia and off-label in other psychiatric disorders
    • It is unlikely that a drug will be approved for CIS within the next five years
  • Appendix A
    • Bibliography
    • Websites
  • Appendix B
    • Physician sample breakdown
    • Physician research methodology
  • Appendix C
    • Physician questionnaire
    • SECTION 1 Epidemiology and diagnosis of CIS
    • Section 2 Treatment
    • Section 3 Drug profiles
    • Report methodology
    • Date of research completion
    • About Datamonitor
    • About Datamonitor Healthcare
    • Datamonitor Healthcare's research and analysis methodologies
    • Datamonitor Healthcare's therapy area capabilities
    • About the CNS analysis team
    • Key therapy team members
    • Lynda Lynch, Director CNS
    • David Abramson, Therapeutic Lead Consultant
    • Disclaimer